Individual
JESSICA A ROADT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2901 W KINNICKINNIC RIVER PKWY STE 310, MILWAUKEE, WI 53215-3660
(414) 649-3990
Mailing address
2901 W KINNICKINNIC RIVER PKWY STE 310, MILWAUKEE, WI 53215-3660
(414) 649-3990
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
354423
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1295118487
—
WI
01
—
K400397443
MEDICARE PTAN
WI
Enumeration date
07/07/2015
Last updated
07/21/2022
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